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MC-13-249Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 185435 Permit Number: MC -2 -13 -249 Scheduled Inspection Date: April 10, 2013 Inspector: Perez, JanPierre Owner: RUBIO MEDEROS, ELIZABETH Job Address: 374 NE 95 Street Miami Shores, FL 33138- Project: <NONE> Contractor: FELCO AIR CONDITIONING INC Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (786)261 -4920 Parcel Number 1132060136060 Building Department Comments REPLACE 4 TON AND 2 TON AC UNITS Infractio Passed Comments INSPECTOR COMMENTS False 4 itab Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 10, 2013 For Inspections please call: (305)762 -4949 Page 10 of 28 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B D G PERMIT APPLICATION Permit Type: MECHANICAL JOB ADDRESS: 374 NE 95 ST FEB 0 7 201 FBC 20 LD Permit No. m(J 3 -d1a '3 -P, Master Permit No. • City: Miami Shores County: Miami Dade Folio/Parcel #: 11- 3206 -013 -6060 Is the Building Historically Designated: Yes X NO Flood Zone: zip: 33138 OWNER: Name (Fee Simple Titleholder): ELIZABETH RUBIO MEDEROS Phone#:786-261 -4920 Address :374 NE 95 ST City: MIAMI SHORES Tenant/Lessee Name: Email state: FL 01A- zip: 33138 Phone#: CONTRACTOR: Company Name: FELCO AIR CONDITIONING Address: 11930 SW 128 AVE City: MIAMI State: FL Qualifier Name: FELIX CORREA Phone#: 305 -221 -4471 zip: 33186 Phone#: 305- 221 -4471 State Certification or Registration #: CAC057200 Certificate of Competency #: Contact Phone #: 305 - 2214471 Email Address: MRCOHIBA @BELLSOUTH.NET DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $7,000 Square/Linear Footage of Work: Type of Work: ©Address OAI ONew r, • epair/Replace Description of Work: REPLACE EXISITIN 4 TON A�t D 2 TON AIR CONDITIONING SPLIT SYSTEM WITH HEAT (15 KW TOTAL). ODemolition * * ** x�+��x�e «*�r,��n* ** *d�*** * *a��x *e *** * *** *F **5*************************************** Submittal Fee $ �`� Permit Fee $ j 9 a ° CCF $ CO /CC $ canning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE Is ' Ski Zit( 9J Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State ZIP Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) s after the building permit is issued. In the absence of such posted notice, the inspection will NO approved einspec o fee will be charged. Owner per Agent The foregoing instrument was acknowledged before me this UR ,20 >byEUZ VI o\l who io personally know-71707)m r who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: ktl, i9 Print: My Commission Expires: N.".Zki, LITEiH BUCHBYmER * MY COMMISSION i EE 882884 EXPIRES: December 12, 2018 BmbdThrobigdNoisy Seta ******************************M*** x*********** * * * * *a•xa **** * ** ** * *r * **** s *ee**** **** xa******wrva** ******* Signature Co i ' ctor The fore oing instrument was ac owledged before me this a �j day of ��.�..�.�%.[� `201 � %� �,1LVI; who is ., all own to me or who has produced lion and who did take an oath. Ern., ire8@nded Through National Notary Assn. APPROVED BY "i j , Plans Examiner Structural Review Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk ACCORD- ' .-- CERTIFICATE OF LIABILITY INSURANCE °A' 01 /3'D'Y"YY' 01!30113 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1 Jimenez & Co., Inc. 8000 Coral Way Miami, FL 33155 Phone (305) 264 -9900 Fax (305) 2645382 NoNA CT JULIO JIMENEZ R% Ext): (305) 264 -9900 ialC, No): (305) 264-5382 L RESS. jullot jimenezandcompany.com INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: ASCENDANT COMMERCIAL INSURANCE INSURED FELCO AIR CONDITIONING 11930 sW 128 ave Miami, FL 33186 INSURER B 01/11/201 INSURER C : EACH OCCURRENCE INSURER D : 01/11/2014 / / INSURER E : $ 100,000.00 INSURER F : $ 5,000.00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R TYPE OF INSURANCE ADDLSUBR MSR WVO POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY • ❑ CLAIMS -MADE OCCUR GL- 393541 01/11/201 EACH OCCURRENCE $ 1,000,000.00 01/11/2014 / / DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one poison) $ 5,000.00 PERSONAL A ADV INJURY $ 1,000,000.00 • GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER • POLICY ❑ PRO- ❑ LOC 'IN T- PRODUCTS - COMP/OP AGG $ 1400,000.00 $ LIABILITY • ANY AUTO ■ ALL QWNED ❑ SAUTOS LED NON -OWNED II HIRED AUTOS ❑ AUTOS ❑ r COMBINED Bd SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Wag e"' DAMAGE (Par ecddem) $ $ • UMBRELLA 1-148 • OCCUR NI EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AW EMPLOYERS' LIABILITY Y 1N ANY PROPRIETOR/PARTNER/EXECUTWE N/A ❑ WC STATU- ri ()TH- EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS ! LOCATIONS 1 VEHICLES (Attach ACORD 901, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept 10050 NE 2 Ave Miami Shores, Fl 33138 ACORD 25 (2010/05) QF SH TH A OF ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ON TE THEREOF, NOTICE WILL BE DELIVERED IN E W 'L THE POLICY PROVISIONS. 1988 -2010 ACORD CORPORATION. All rights reserved. e ACORD name and logo are registered marks of ACORD EfiNSEr 065318-9 BUSINESS NAME / LOCATION FELCO AIR CONDITIONING INC 11930 SW 128 AVE 33186 UNIN DADE COUNTY FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY RENEWAL RECEIPT NO. 065318-9 STATE= CAC057200 OWNER FELCO AIR CONDITIONING Sec. Type of Business 196 SPEC MECHANICAL CONTRACTOR THIS IS ONLY A LOCAL RECEIPT. IT DOES NOT�PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. INC PAYMENT RECEIVED MIAMI -DADE COUNTY TAX COLLECTOR: 07/18/2012 09010062001 000075.00 SEE OTHER SIDE FELCO FELIX 11930 WORKER /S 10 DO NOT FORWARD AIR CONDITIONING INC J CORREA JR SW 128 AVE MIAMI FL 33186 111111111111, Miff lit Ill III l itlf1itlfltlilt1it111111111 d ' CERTIFICATE OF INSURANCE This certifies that ►:± STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois D STATE FARM FiRE AND CASUALTY COMPANY, Scarborough, Ontario ID STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida STATE FARM LLOYDS, Dallas, Texas Ensures the following policyholder for the coverages indicated below: Name of policyholder Address of policyholder Location of operations Description of operations FELCO AIR CONDITIONING INC FO 11930 Sw 128TR AVE 11930 Sw 128TH AVE Air Conditioning The policies listed Blow have been Issued to the policyholder for the policy periods shown, The insurance described In these policies is subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY NUMBER This insurance Includes: POUCY PERIOD TYPE OF INSURANCE Effec ,lye pat ; Expiration Date Comprehensive ve Business Liability Products - Completed Operations Contractual Liability ❑ Underground Hazard Coverage ❑ Personal Injury ❑ Advertising injury ❑ Explosion Hazard Coverage D Collapse Hazard Coverage 0 0 EXCESS LIABILITY ❑ Umbrella ❑ Other POLICY PERIOD Effective Date Expiration Date POLICY NUMBER 98- BH- 13367.8 F TYPE OF INSURANCE WORICHRS COMP POLICY PERIOD Effective Date 01/11/2013'; 01/11 /2014 A\t, LiMITS OF LIABILITY (at beginning of policy period) BODILY INJURY AND PROPERTY DAMAGE Each Occurrence $ General Aggregate $ Products — Completed $ Operations Aggregate BODILY INJURY AND PROPERTY DAMAGE (Combined Single Limit) Each Occurrence $ Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY Each Accident $ Disease Each Employee $ ase - Policy Limit $ LIMITS OF UABILITY (at beginnin . of • olio • riod 100,000 THE CERTIFICATE OF INSURANCE iS NOT A CONTRACT CF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described polides a : canceled before its expiration date, State Farm to mad a written notice to the ceWffca � , [der Name'and Address of Certificate Holder Miami Shores Village Bldg Dept. 10050 NE 2 ,Ave Miami, Shores, Fl 33138 658-904 a.3 041999 Printed In U.S.A. days before Ca�a .however, we fail to mail r-: such nonce, na , ; i •iii will be imposed on State Fa ,. , AP/4 , , r ill be representatives. if, rf`'orized Signature CSR Agent's Cade Stamp AFO Cade F606 epresentative 01/25/1013 Date wwmststiz.arg - DeparltnEsit et Stabs Contact Us E-Filing Services Document Searches Forms Help No Events No Name History Detail by Entity Name Florida Profit Corporation FELCO AIR CONDMONING, INC. Entity Name Search I Submit 1 Filing Information Document Number G70076 FEI/8N Number 592370876 Date Filed 11/15/1983 State FL Status ACTIVE Principal Address 11930 SW 128 AVE MIAMI FL 33186 US Changed 04/22/1997 Mailing Address 11930 SW 128 AVE MIAMI FL 33186 US Changed 04/22/1997 Registered Agent Name & Address CORREA, FELIXJ JR 11930 SW 128 AVENUE MIAMI FL 33186 US Name Changed: 04/26/2000 Address Changed: 07/30/1996 Officer/Director Detail Name & Address Title PSTD CORREA, FELIXJ JR 11930 SW 128 AVE MIAMI FL 33186 Annual Reports amaitsunbizorg/serktslcordeLexeladiorsDETRAintsloc number=G700768inq_came fronNAMFWD8ccr web names seq nurnber=0:100&names nam... 1/3 1/31/13 Report Year Filed Date 2010 01/10/2010 2011 02/16/2011 2012 03/19/2012 Document Images litWastatizorg - Department of State I View image in PDF format I I View image in PDF format I 1 View image in PDF forrnat 1 View image in PDF format 1 1 View image in PDF format 1 I Vie*/ irnage in PDF format 1 View image in PDF format 1 View image in PDF format 1 1 View image in PDF format 1 View image in PDF format 1 View image in PDF format 1 1 View image in PDF fonnat 1 View image in PDF format 1 1 View image in PDF format 1 1 View image in PDF format 1 1 View image in PDF format 1 1 View image in PDF format 1 INote: This is not official recotri. See documents if question or conflict. I www.sistizorgIscriptsicorcht.cen?actioDETFIL.8inq doc rsimber=G70076&inq_carre fronNAIVIFI/VD&cor %en names seq_nuater--030081menes nem.. 2/3 No Events No Name History wsw.stediz.' org-Departmentc1Shate Entity Name Search I Submit www.sunbiz.org/scripts/cordetexe?acliorpDETFIL&Mq doc nurnber=G700768tinq_came frorrNAMFWD8icor web names seq_number=0C008,names_nam... 3/3 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION? YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: 'Rk. I✓L. Q r y-g /Vrker7. BUSINESS ADDRESS: it 610 S(K) ' J AWE CITY IM (64 w/1( STATE ZIP CODE 33 k U IQ BUSINESS PHONE: (3O.x) 221. -I-i ( FAX NUMBER ( ) CELL PHONE (VS- ) Cr740 G13°I °I QUALIFIER'S NAME: FAA- ( C.oIR. U tgl QUALIFIER'S LIC NUMBER: CAC 0 S 2..V b EMAIL ADDRESS (IF APPLICABLE): JA VO-CO N1 L C Vkusou-r AIfc:[ Created on 3119109 BY MLDY / RV 3129 MLDV